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amitriptyline
generic
Black Box Warnings .
Suicidality
incr. suicidality risk in children, adolescents, and young adults w/ major depressive or other psychiatric disorders; weigh risk vs. benefit; in short-term studies of antidepressants vs. placebo, suicidality risk not incr. in pts >24 yo, and risk decr. in pts 65 yo and older; depression and certain other psychiatric disorders themselves assoc. w/ incr. suicide risk; observe all pts for clinical worsening, suicidality, or unusual behavior changes; advise families and caregivers of need for close observation and communication w/ prescriber; not approved for peds use
Adult Dosing .
Dosage forms: TAB: 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, 150 mg
depression
- [50-150 mg PO qhs]
- Start: 25-75 mg PO qhs, may incr. by 25-50 mg/day q2-3 days; Max: 300 mg/day; Info: start 10-25 mg PO qhs in elderly pts, may incr. by 10-25 mg/day q2-3 days; may give in divided doses; taper dose gradually to D/C
neuropathic pain, diabetic (off-label)
- [25-100 mg PO qhs]
- Start: 25 mg PO qhs, titrate slowly; Max: 150 mg/day; Info: taper dose gradually to D/C
post-herpetic neuralgia (off-label)
- [75-150 mg PO qhs]
- Start: 10-25 mg PO qhs, may incr. by 10-25 mg/day qwk; Max: 150 mg/day; Info: taper dose gradually to D/C
migraine prophylaxis (off-label)
- [10-100 mg PO qhs]
- Start: 10-25 mg PO qhs, titrate slowly; Max: 150 mg/day; Info: taper dose gradually to D/C
tension-type headache prophylaxis, chronic (off-label)
- [20-75 mg PO qhs]
- Start: 10-25 mg PO qhs, may incr. by 10-25 mg/day qwk; Info: taper dose gradually to D/C
fibromyalgia (off-label)
- [25-50 mg PO qhs]
- Start: 10 mg PO qhs, may incr. by 10-25 mg/day qwk; Max: 75 mg/day; Info: taper dose gradually to D/C
IBS (off-label)
- [50-100 mg PO qhs]
- Start: 10 mg PO qhs, titrate slowly; Max: 100 mg/day; Info: taper dose gradually to D/C
cyclic vomiting syndrome prophylaxis, moderate-severe (off-label)
- [75-150 mg PO qhs]
- Start: 25 mg PO qhs, incr. by 10-25 mg/day q2wk; Info: taper dose gradually to D/C
renal dosing
- [no adjustment]
- renal impairment: no adjustment
- HD/PD: no adjustment; no supplement
hepatic dosing
- [see below]
- hepatic impairment: not defined, caution advised
Peds Dosing .
- Dosage forms: TAB: 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, 150 mg
neuropathic pain (off-label)
- [0.5-2 mg/kg/dose PO qhs]
- Start: 0.1 mg/kg/dose PO qhs, titrate slowly over 2-3wk; Info: taper dose gradually to D/C
migraine prophylaxis (off-label)
- [2 yo and older]
- Dose: 0.25-1 mg/kg/dose PO qhs; Start: 0.1-0.25 mg/kg/dose PO qhs, may incr. by 0.1-0.25 mg/kg/dose q2wk; Max: 2 mg/kg/day or 75 mg/day; Info: divide dose bid if >1 mg/kg/day; taper dose gradually to D/C
cyclic vomiting syndrome prophylaxis (off-label)
- [>5 yo]
- Dose: 1-1.5 mg/kg/dose PO qhs; Start: 0.25-0.5 mg/kg/dose PO qhs, incr. by 5-10 mg/day qwk; Info: taper dose gradually to D/C
renal dosing
- [not defined]
- renal impairment: consider adult renal dosing for guidance
- HD/PD: consider adult renal dosing for guidance
hepatic dosing
- [see below]
- hepatic impairment: not defined, caution advised